In California’s workers’ compensation system, medical evaluations are often the battleground where key disputes over treatment and disability ratings are resolved. As a defense attorney, protecting the interests of employers and insurance carriers requires a solid understanding of Labor Code 4062.3, which governs communication with medical evaluators, particularly Qualified Medical Evaluators (QMEs) and Agreed Medical Evaluators (AMEs).
Labor Code 4062.3 plays a critical role in ensuring that medical evaluators remain neutral and that the evaluation process is fair. For defense counsel, adhering to the rules set forth in this statute is essential to maintaining credibility and protecting your client’s interests.
What Does Labor Code 4062.3 Say?
The core focus of Labor Code 4062.3 is transparency and fairness. The statute ensures that communication between the parties (employers, insurers, injured workers, and attorneys) and the medical evaluator follows strict protocols. This helps prevent one-sided influence or “ex parte” communication that could unfairly sway the evaluation.
Here’s a closer look at how Labor Code 4062.3 impacts the defense in workers’ compensation cases:
Key Rules for Defense Counsel to Follow
- All Communication Must Be Written and Shared Any communication between you and the QME or AME must be in writing and copied to all parties. The law forbids ex parte communication, which ensures that both sides have equal access to the information provided to the evaluator. As a defense attorney, it is critical to keep all lines of communication transparent.
- Agreement on Information Submitted to Evaluator Before providing any documents to the evaluator, both parties must agree on what is relevant and necessary. As defense counsel, you may encounter pushback from the applicant’s attorney on the scope of medical records or other documents provided to the QME or AME. If there is disagreement, a workers’ compensation judge can step in to decide what materials should be submitted.
- Providing Relevant Medical Records Only The documents you submit to the evaluator must be relevant to the medical issues in dispute. This includes medical treatment records, diagnostic results, and other pertinent materials. Flooding the evaluator with irrelevant information could backfire, and you run the risk of the applicant’s attorney objecting to the material. Sticking to what is directly relevant helps to streamline the evaluation process and maintains your credibility with the evaluator.
- Handling New Medical Information If new medical reports or information arise after an evaluation has been scheduled, they can still be submitted to the evaluator, provided they follow the same procedural steps. Both parties have an opportunity to review and agree on this new information. For defense attorneys, timely submission of updated or clarifying records is essential in preventing delays and ensuring that your client’s side of the story is fully considered.
- Consequences of Ex Parte Communication One of the most significant risks under Labor Code 4062.3 is ex parte communication. If one party communicates privately with the evaluator, it can result in the evaluator’s report being thrown out. This means additional costs and delays for your client, not to mention the possible selection of a new evaluator, which could be more favorable to the applicant’s case. Avoiding any unilateral communication with the QME or AME is critical.
Why Labor Code 4062.3 Matters for Defense Attorneys
From a defense perspective, Labor Code 4062.3 levels the playing field by ensuring transparency and impartiality in the medical evaluation process. While the statute is designed to prevent either side from unfairly influencing the QME or AME, it also protects your client from having an applicant’s attorney manipulate the process in their favor.
The law gives defense attorneys the tools to carefully manage what medical information the evaluator sees. By negotiating and, if necessary, litigating the inclusion or exclusion of certain documents, you can ensure that the QME or AME bases their report on accurate and relevant information.
Strategic Use of Labor Code 4062.3
In some cases, the strategy may involve negotiating early with the applicant’s attorney to reach an agreement on an Agreed Medical Evaluator (AME). This approach can sometimes lead to more favorable outcomes for both sides, as an AME is jointly selected and may reduce the likelihood of drawn-out disputes. However, whether using a QME or AME, the key is to adhere strictly to Labor Code 4062.3 to avoid unnecessary setbacks.
Conclusion
Labor Code 4062.3 is a critical piece of California workers’ compensation law, especially for defense attorneys representing employers and insurance carriers. It governs the rules of engagement with medical evaluators, ensuring transparency and neutrality in a process that is often fraught with contention.
By following the guidelines of this statute, you can avoid costly missteps and work to secure a fair and objective evaluation that protects your client’s interests. At Yrulegui & Roberts, we understand the complexities of workers’ compensation defense and are here to guide you through the nuances of Labor Code 4062.3. Contact us to learn more about how we can assist in your defense strategy.
